What Caused the Obesity Epidemic?

What caused the obesity epidemic? What are the consequences? 

HOUSTON – When it comes to the childhood obesity epidemic, the prevailing narrative is that overweight children — and their parents — lack the collective will power to put down the potato chips, pick up a jump rope and work at losing weight.

“… doctors specializing in obesity and weight loss say certain scientific and societal factors — including genetics, the rise of processed foods that include soybean oil and national overconsumption of sugar-sweetened beverages — are more likely to blame for childhood obesity than lazy kids or indulgent parents.

“Obesity is a disorder which, like venereal disease, is blamed upon the patient,” says obesity researcher Dr. George Bray, the opening lecturer at the first annual U.S. News Combating Childhood Obesity summit, held at Texas Children’s Hospital.

It’s the blame issue that stands in the way of progress in fighting obesity as a disease, when larger factors that can’t be controlled may be at the heart of the issue, says Bray, professor emeritus of the Pennington Biomedical Research Center at Louisiana State University, who has been studying obesity among children for several decades.

“Obesity isn’t a disease of willpower — it’s a biological problem,” he says. “Genes load the gun, and environment pulls the trigger.”

In a panel analyzing why weight is difficult to lose, Kevin Hall, an obesity and diabetes researcher, says a new study he co-produced points the finger at highly processed food.

His study, published Thursday in the medical journal Cell Metabolism, showed that patients who ate minimally-processed food with easily identifiable ingredients ate less, and lost weight without trying, when compared with a group that had highly-processed, prepackaged, ready-to-eat food, even though the diets prepared for both groups had the same number of calories and macronutrients.

“What we saw, on average, was that people consumed 500 calories more” on the processed-food diet than those who ate food that didn’t go through a factory, says Hall, chief of the integrated physiology section at the National Institute of Diabetes and Digestive and Kidney Diseases. “The ones on the unprocessed diet — they spontaneously lost weight.” It has been proposed that eating a diet for health (whole, “real” foods) can cause weight loss and maintenance of the loss compared to those who primary goal was simply weight loss alone.

In opening the summit, presenters tackled a question doctors and obesity researchers have grappled with a difficult question in fighting the disease: How did we get here?

Bray says studies trace the epidemic back to the ’60s and ’70s, when U.S consumption of soybean oil, most likely through processed-food production, spiked and, around the same time, Americans, including children, started to weigh more. Fats found in soybean oil, he says, were found in breast milk samples from the era.

“The fats in our food supply may well be playing a part in our inability to regulate” food intake, Bray says. However, this is just the tip of the iceburg. Likewise food portions have been shown graphically to double the size of those served beginning inn the 1970’s.

Meanwhile, the consumption of sugary soft drinks like Coke and Pepsi increased from just a few gallons per person per year to more than triple that by the end of the century. The rise of soft drink consumption between 1950 and 2000, he says, paralleled the increase in obesity; pregnant women who drank sugary soft drinks, Bray added, ended up passing the sugar on to their unborn children.

“It’s kind of maternal abuse of the fetus” where “the child has no control, only the mother has,” he says.

The U.S. News Combating Obesity summit convened top medical experts, hospital executives, pediatricians, community health leaders, advocates to exchange ideas and share practices that are helping to combat the nationwide obesity epidemic.

The percentage of children and adolescents affected by obesity “has more than tripled since the 1970s,” according to the Centers for Disease Control and Prevention. According to data from 2015-2016, the CDC reports, “nearly 1 in 5 school age children and young people (6 to 19 years) in the United States has obesity.”

Experts say the epidemic has long-term ramifications: Obese children who carry the weight can exhibit heart disease and type 2 diabetes as well as mobility and self-esteem issues. Unfortunately in order to reverse this trend, cultural changes will be required at many levels, to say the least. Can it happen?

U.S. News and World Report

Joseph P. Williams, Senior Editor

May 16, 2109

Scientific, Societal Factors to Blame for the Obesity Epidemic

Weight Gain? The Brain and Gut Disconnect?

“A good predictor of who will gain weight is who says they plan to lose some. Last year, 108 million Americans went on diets. Long-term studies of dieters find that they’re more likely to end up gaining weight in the next two to fifteen years than people who don’t diet.” Sandra Aamodt, Ph.D. Why Diets Make Us Fat. 2016.

Rebound’ Weight Gain: A Disconnect Between Brain and Gut May Be a Factor

Healthline. By Christopher Curley, September 15, 2022

Fact Checked: Jennifer Chesak

“Experts say weight gain after weight loss is common among adults and children.

  • Researchers say a new study indicates that a disconnect between the brain and the gut may be a reason that people tend to gain weight after initially losing weight.
  • They say in many people who have lost weight their gut will tell them they’re full after eating a meal, but their brain will try to tell them they’re still hungry.
  • Experts say the disconnect may be due to the body’s attempt to store fat during weight loss.

Nearly halfTrusted Source of adults in the United States try to lose weight each year, but many will not keep that weight off long-term.

In fact, only about one in five people who are overweight can maintain weight loss for a year or longer, research showsTrusted Source.

While there are many competing theories about why that is, ranging from psychological to biological, a new study of children with obesity suggests the answer might lie in a disconnect between gut hormones and brain signals.

Researchers at Seattle Children’s Hospital in Washington put children with obesity on a 24-week weight loss program, monitoring their brain activity and gut hormone responses before and after the trial.

At the end of the weight loss program, the researchers reported that after eating a meal the children’s gut showed normal levels of regulatory hormones indicating that they were full and satisfied.

Their brains, however, showed levels of activity signaling that they were still hungry.

The researchers also found that the more weight a child lost, the more likely they were to react to food cues after completing a meal —their brain essentially telling them they were still hungry while their gut was telling them the reverse.

“Our results imply that during weight loss intervention, your body acts to conserve fat through maintaining hunger responses in the brain and that this needs to be addressed,” Dr. Christian Roth, a lead study author and professor at Seattle Children’s Hospital, said in a press release.

Roth said larger, more extensive studies would be required to confirm these findings.

“It would also be useful to investigate how long the disconnect between central and local appetite regulation persists after maintained weight loss, to guide intervention plans,” he added.

“This is a very interesting study and I think that a lot of these findings are applicable to adults as well,” said Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California.

“I see in my patients that they feel the need to eat, even if their stomach feels full,” Ali told Healthline. “There is certainly a strong psychological component to eating behavior that surgery and medications cannot always address completely.”

“I feel this research is on the right track and we need to find a way to satisfy the brain as well as the gut,” he added. “This will require extensive research in both children and adults to find the right solution.”

Beyond hormones

One of the more notable aspects of the study is how it complicates our understanding of how hormones affect appetite and rebound weight gain.

Previous studies have shown that an increase in appetite hormones after weight loss might be a key driver of these rebound gains.

The results of this study paint a more nuanced picture where even if gut hormones are normal, the brain is out of sync.

“The study underscores our understanding of obesity and weight homeostasis as a chronic disease of the brain,” said Dr. Mert Erogul, an attending physician at Maimonides Medical Center in New York.

“The regulation of appetite is enormously complex and layered,” he told Healthline. “From the digestive tract, there are hormones that signal fullness, such as leptin, CCK, and peptide YY. There are also hormones that signal hunger, such as ghrelin. These are in constant interplay with seemingly subjective feelings that come from the brain such as food preference and liking as well as motivation to eat.”

Ultimately, experts say this may require a holistic approach to weight loss and maintaining a healthy weight.

“Rebound weight gain is very common and happens for many physiological, behavioral, and psychological reasons,” said Dr, Steve Patching, a medical director of bariatric surgery at Sutter Hospital in Sacramento, California.

“Believe it or not, weight loss actually sets up your body for weight gain,” he told Healthline. “This is because the body always strives for symbiosis. This is why we often still feel hungry or even starving after we eat a ‘normally satiating’ meal. It is also why correct weight loss should be done slower than we often want.”

Weight loss needs to occur in the context of a durable commitment to changes in diet and lifestyle,” he said. “Even then, obesity medicine specialists recognize that people who are overweight often need lifelong therapy with medications to maintain weight loss.”

Are Herbal Supplements Safe?

Are Herbal Supplements Helpful or Harmful?

 Herbal supplements are popular as “natural” remedies. Are they useful for health or are they a health risk? Today, about 1 in 6 Americans use herbs to treat everything from coughs, constipation, and poison ivy, and arthritis. They are widely available and affordable and don’t require a prescription. Advocates claim this makes people more in control of their own health care; opponents fear that self-dosing may lead to toxic interactions and prevent people from seeking traditional care and proven treatments offered by conventional practitioners.

Some herbs are derived from plants in the first place. For example, aspirin comes from willow bark and digitalis from foxglove flowers to treat certain heart problems.  The active ingredients may come from all the parts of the plant, so the amounts contained are affected by harvesting and processing and vary with the batch. This practice may further upset the balance of the ingredients and the doses are often affected. Herbs are made from unpurified plant material, and there is also a risk of contamination with pesticides, microbes, metals and other unnamed toxins.  

Another concern is that some herbs interact with prescription drugs and cause additional problems. For example, gingko biloba and garlic can interfere with blood clotting and should not be used with blood-thinners before surgery. St. John’s wort may interact with anesthetics and antidepressants.

 Herbs are medicines and like taking other medications has some advantages and risks. Whether they are helpful or harmful depends on the supplement, the dose, and the consumer. Education is essential in the pros and cons of any medication as well as herbal remedies. The best advice is “buyer beware”.  This advice applies to all dietary supplements due to a lack of much-needed regulations on safety and effectiveness.

Immunity and Metabolic Syndrome

The Metabolic Syndrome and the Immune System

The metabolic syndrome is not a disease alone but is a cluster of related disorders that include:

  • Excess fat around the waist (>40 inches or more (men)and >35 inches or more for women).
  • Blood pressure of 130 /85 mmHg or higher, or being on blood pressure medication
  • Triglycerides above 150 mg/dl
  • Fasting blood glucose greater than 100 mg/dl, or being on glucose-lowering medications
  • High density lipoprotein (HDL) less than 40 mg/dl for men or less than 50 mg/dl for women.

A person can be considered to have metabolic syndrome if they have at least three of these conditions.

An important function of the immune system is to provide healthy, short-term (acute) inflammation that is normal in most situations. This is necessary for the immune function to battle injuries made from disease-causing bacteria, and viruses (antigens). What results is redness, swelling, heat, sometimes fever, and pain.

However, one of the unhealthiest conditions is paradoxically chronic inflammation that ultimately can result in complications, and even a greater risk of death. The greater overreaction of immune system components is often referred to a “cytokine storm”. Cytokines are small proteins that are used to convey information. I call them “messengers”. They play a crucial role in the development of diseases and how your cells are able to respond. In a sense, cytokines are the language of your immune system.

Chronic inflammation can come from the accumulation of belly fat as well as low levels of HDL cholesterol, which normally can have anti-inflammatory properties. (Scott Butsch, MD, Director of Obesity Medicine at the Bariatric and Metabolic Institute at Cleveland Clinic.)

“Those with metabolic syndrome typically have low levels of HDL and thus, have less of its beneficial properties to fight infection”, says Dr. Butsch. This can also occur with aging, poor diet, and other unhealthy practices.

How Does Obesity affect the Immune System?

“One of the many reasons obesity is such an unhealthy thing is that fat tissue produces loads of inflammatory cytokines. So even on a good day, an obese person has a lot of inflammatory biomarkers (signals) in their system. When infected by the coronavirus, for example, their starting point is already worse, they are already more inflamed than they should be. In any case, the coronavirus pandemic was a stark reminder of why your immune system is so incredibly important and why we should all benefit from understanding it better.” (Immune: A Journey into the Mysterious System that Keeps you Alive. Philipp Dettner. 2021).

According to Dr. Butsch, “obesity impairs the response of immune cells that “remember past viruses so you can attack that virus effectively the second time you may encounter it. This is why obesity is linked to an increased failure of vaccines”

How Can You Improve Immunity with Metabolic Syndrome?

“Losing weight is the key to improve your metabolic syndrome biomarkers as well as your immune system responses. When you lose some extra weight, your fat cells shrink and cause an improvement in systemic chronic inflammation,” Dr. Butsch says. Increasing your physical activity may also help. In this case, this is one time that eating less and moving more is primary to decreased inflammation, metabolic syndrome biomarkers and its complications from infectious diseases.

Alternative Medicine?

Complementary and Alternative Medicine Practices

Consumer interest in alternative medical practices has been around for several decades – the last known data acknowledges that at least 34% of people recently surveyed in the U.S. used some type of alternative, complementary and integrative medicine in the past year. This resulted in about $30 billion generated to this industry. (2016 Data)

Most alternative medicine consumers have illnesses for which conventional medicine cannot offer a cure, such as arthritis, terminal stages of AIDS, and stress-related conditions. The mind is a powerful component of many of the treatments, which is proven in many trials as a placebo effect. There are lots of possible reasons that something like a folk medicine or a homeopathic preparation may work. In addition to belief of the mind-body effects of the “medication” as well as the normal ups and downs of symptoms, the remission of the disease, the denial of symptoms or misrepresentation of effectiveness by people who believe the remedy is effective. The body can be a powerful healer under the right conditions.

Many clients wish physicians would take the time to explain (in simple terms) the nature of the problem, to acknowledge nutritional influences on health, rather than just recommend drugs and surgery as the only approaches for treating illness; to answer questions about dietary supplements, be sensitive to mind-body interactions, and to respect questions about alternative therapies. My Granddaughter is in her second year of medical school – I will be anxious to hear how and if she receives any of these practices in her training.

To date, few alternative therapies have been subjected to scientific scrutiny, and many of the practices are based on presumptions that are unconvincing at best, yet some, e.g. acupuncture and chiropractic show promise in certain conditions.

Herbal medicine.   By definition, an herb is a plant or any of its parts that is used primarily for medicinal purposes. This includes aromatherapy. Dosage forms include capsules, tablets, extracts, or tinctures, powders, teas, creams, and ointments. In March 1999, FDA established regulations that require the labels of such supplements to include name, quantity, dosage per day, and ingredient amounts.

Fraudulent claims for diet-and health related remedies have always been a part of our culture. It is important to scrutinize the credentials and motives of anyone providing medical or health advice. “Let the buyer beware.” Unfortunately, if it sounds too good to be true, it probably is.

Reference: Gordon M. Wardlaw. Contemporary Nutrition, Issues, and Insights. Fifth Edition.

Poor Diets = Standard American Diet

“Poor diets in the US are a national security threat” – CNN

By Gisela Crespo, CNN ! Updated 2:43 PM ET, Mon July 20, 2020
(CNN) — America’s poor diet isn’t just bad for us. It’s now considered a threat to national security. Diet-related illnesses are a growing burden on the United States economy, worsening health disparities and impacting national security, according to a white paper published Monday in the American Journal of Clinical Nutrition. Poor nutrition is the leading cause of illnesses in the US, with unhealthy diets killing more than half a million people each year, a group of experts who have formed the Federal Nutrition Research Advisory Group wrote in the paper. About 46% of adults in the country have an overall poor-quality diet, and this number goes up to 56% for children, according to the paper. Related Article: Add fruit, veggies and grains to diet to reduce type 2 diabetes risk by 25%, studies say for the most vulnerable Americans.” Meanwhile, US healthcare spending has nearly tripled from 1979 to 2018, from 6.9% to 17.7% of the gross domestic product. These increases in health spending, the advisory group said, affect government budgets, the competitiveness of the US private sector and workers’ wages. Diet-related health disparities affect minority, rural and low- income communities. “While social and economic factors such as lower education, poverty, bias, and reduced opportunities are major contributors to population disparities, they are likewise major barriers to healthy food access and proper nutrition,” the paper reads. “Poor diets lead to a harsh cycle of lower academic achievement in school, lost productivity at work, increased chronic disease risk, increased out-of-pocket health costs,

The paper’s authors called for the expansion of federal investment in nutrition science by creating a new Office of the National Director of Food and Nutrition or a new US Task Force on Federal Nutrition Research, with the goal of improving coordination within the agencies that budget for research in this topic.

The paper also called for “accelerating and strengthening” nutrition research within the National Institutes of Health by creating a new National Institute of Nutrition.

“Every day, our country suffers massive health, social, and economic costs of poor diets,” said Dr. Dariush MozaWarian, co-author of the paper and dean and Jean Mayer Professor of Nutrition at the Friedman School of Nutrition Science and Policy at Tufts University.

Fruit and Vegetables: Disease Fighters!

Phytochemicals: What They Do for Health?

Cruciferous Vegetables

You can’t go wrong with increasing your intake of plants from the Brassica family – broccoli, cabbage, kale, cauliflower, and Brussels sprouts. There are many studies that even help to prevent cancer and heart disease. What makes them so powerful?  They are high in dietary fiber, polyphenols (phytochemicals) and provide over 40 phenolic compounds labeled “cruciferous” meaning their leaves grow in a cross-pattern.  There is some extensive research that reports that cruciferous vegetables, especially broccoli, an anticancer phytochemical named isothiocyanates fights breast cancer in particular. By the way, use the stalks and leafy greenss from the plant since they also contain a good amount of nutrients.

Anthocyanins

The red color of many cruciferous vegetables is significant. Anthocyanins are pigments that cause the red and purple coloring of many kales, cabbage, and other colorful vegetables . They can lower blood cholesterol.  One study found that healthy volunteers a fed a beverage of primarily broccoli and cabbage two times a day for three weeks showed a significant decrease in the so-called ‘bad” cholesterol, LDL. Follow up studies produced the same results.

What Other Foods Lower Blood Pressure? One important group is those who contain polyphenols – such as berries. They are a large family of phytochemicals particularly in cardiovascular health. Lycopene in tomatoes has been reported to fight prostate cancer.

Benefits come from their antioxidant, anti-inflammatory, blood vessel dilating properties, and immune system functions. All fruits and vegetables contain polyphenols, but certain ones like berries, cocoa, tea, pomegranate, olives, and grapes contain especially high amounts. All work together so it’s best to consume them that way and in their natural forms.

Phytochemicals: What Do They Do for Health.

Cruciferous Vegetables

You can’t go wrong with increasing your intake of plants from the Brassica family – broccoli, cabbage, kale, cauliflower, and Brussels sprouts. There are many studies that even help to prevent cancer and heart disease. What makes them so powerful?  They are high in dietary fiber, polyphenols (phytochemicals) and provide over 40 phenolic compounds labeled “cruciferous” meaning their leaves grow in a cross-pattern.  There is some extensive research that reports that cruciferous vegetables, especially broccoli, an anticancer phytochemical named isothiocyanates fights breast cancer in particular.

Anthocyanins

The red color of many cruciferous vegetables is significant. Anthocyanins are pigments that cause the red and purple coloring of many kales, cabbage, and other colorful vegetables. They can lower blood cholesterol.  One study found that healthy volunteers a fed a beverage of primarily broccoli and cabbage two times a day for three weeks showed a significant decrease in the so-called ‘bad” cholesterol, LDL. Follow up studies produced the same results.

What Other Foods Lower Blood Pressure? One important group is those who contain polyphenols – such as berries. They are a large family of phytochemicals particularly in cardiovascular health. Their benefits come from their antioxidant, anti-inflammatory, blood vessel dilating properties, and immune system functions. Certain ones like berries, cocoa, tea, pomegranate, olives, and grapes contain especially high amounts. However, all work in synergy so try to combine them together as much as possible. This action is what makes a plant-based diet easier to follow.

Source: Judith E. Brown Nutrition Now, 7th Edition

In the News: Keto diets and cancer?

Medical News Today:

New research explores the benefits of keto diets for reversing colorectal cancer in mice.

“Colorectal cancer (CRC) is reported to be the third most common cancer diagnosed in the United States. Studies have shown that high-sugar diets, and excessive consumption of animal protein — especially red meat — increase CRC risk.

On the other hand, studies show that diets involving fasting and caloric restriction are against intestinal tumors in animal models. Whether they may translate over to humans remains unknown.

Recently, researchers conducted a series of mouse studies investigating the underlying protective mechanisms behind a low-carb diet for CRC. A new study demonstrated in a mice model that it prevents colorectal cancer by activating a growth slowing receptor which is found in the lining of the bowel. This receptor may play an important role in preventing cell growth within the intestine,”

Understanding more about the mechanisms underlying the effects of various diets on tumor growth could help researchers develop treatments and preventative options for CRC.

The new study was published in.

Dmitrieva-Posocco, O., Wong, A.C., Lundgren, P. et al. β-Hydroxybutyrate suppresses colorectal cancer. Nature 605, 160–165 (2022). https://doi.org/10.1038/s41586-022-04649-6

Lifestyle and Longevity

Does chronological age always match biological age? According to a recent study, 1500 elderly women aged 64 to 95 years who sit for more than 10 hours a day have cells that are biologically older by 8 years compared to women who are more active. These women had shorter telomeres which are found on the ends of DNA strands. These structures protect chromosomes from degradation and normally shorten with age but more progressively with unhealthy lifestyles such as obesity or smoking.

Aladdin Shadyab. Lead author. Department of Family Medicine and Public Health at UC San Diego School of Medicine.

The research was partly funded by the National Institute on Aging.

Living in a Blue Zone

Longevity appears to not just be due to diet. Lifestyle in general is so important. No one says we have to eat rice and beans every day as they traditionally did in the Blue Zone of Costa Rica. However, there were other factors like keeping active and being social with friends and family. Why not search for the benefits of the Mediterranean diet, to try a more delicious fare?

A DAY of the life of living in a Blue Zone:: Costa Rica

“Aged 94, Saturnino “Sato” Lopez rises early each day, chops wood and takes long walks in a part of Costa Rica that’s a global oddity: like him, people there tend to live a very long time.

Home for Sato is the Nicoya Peninsula, where 1,010 people aged 90 or older live in a so-called “Blue Zone” — five areas around the world where life expectancy is particularly high.

And these people did not move to the peninsula, located in the northwest of Costa Rica. Rather, they have always lived there.

“At my age, I feel well because the Lord gives me strength to walk at ease. I go out, walk maybe a kilometer (around half a mile), or four kilometers, and I return, no problem,” said Lopez.

His house is in a village called Dulce Nombre — Sweet Name — is a sort of nature refuge.

The village’s wood, concrete and stick-and-mud houses are surrounded by vegetation and cicadas drone non-stop. The Covid-19 pandemic has gone easy on this village.

“During the day if I have to sweep the patio, I sweep. If I have to chop wood, I chop, also. A bit of everything,” said Lopez.

Blue Zones –

In the late 20th century, demographer Michel Poulain and a physician named Gianni Pes used a blue marker to highlight on a map the Barbalia region of Sardinia, Italy, where they found people lived a very long time.

In 2005, an American author and National Geographic fellow named Dan Buettner discovered similar characteristics in Loma Linda, California; Ikaria, Greece; Okinawa, Japan, and Nicoya.

So what is their secret?

“The main food is rice and beans. A bit of meat, fruit, avocado. That is what you eat. They say this is good food,” said Lopez.

His neighbors Clementina Espinoza, 91, and her husband Agustin, 100, follow a similar diet.

Espinoza has outlived six of her 18 children. She walks slowly but steadily, and still tosses corn to her chickens, prepares meals and washes up afterward.

Clementina Espinoza, 91, tends to her garden in Nicoya. She exhibits robust energy in a country where the life expectancy is a mere 80. For the world in general it is 72, the World Health Organization says.

“Out in the countryside, life is quieter,” said Espinoza, insisting that diet is key. “You are more relaxed and there is not so much danger.”

– Having purpose is key –

Having goals is critical to aging well, said Aleyda Obando, who works in the social security administration in Nicoya.

“They thank God for being alive and they make plans, to plant something or go see friends,” said Obando. “It is a combination of factors that makes these people last longer.”

It also helps to have a social support network, exercise, eat healthy food and minimize stress.

“We grew corn, rice, beans, everything. “We grew what we ate,” said Clementina. Now, her daughter Maria looks after her.

Agustin, one of 53 people in the area who are 100 or older, is blind now and suffered a stroke.

– Back in the saddle –

Jose Villegas is another centenarian, who lives in the neighboring village of San Juan de Quebrada Honda, with one of his eight daughters.

He is hoping that when he turns 105 on May 4 he can once again ride a horse — he used to make his living on horseback, herding livestock. But sometimes he has trouble with his legs.

Being 104, he says, “is a big deal because God has given me a lot of life. It was not fantastic but it was not bad, either,” said Villegas, sitting in the house he was born in.

“Now, lifestyles have changed. It is not the same as before. Things used to be healthier, and people loved each other a little bit more,” said Villegas, who became a widower seven years ago and spends his evenings listening to folk music.

Gilbert Brenes, a demographer at the University of Costa Rica, said the Blue Zone’s elderly population may peak in the next 20 or 30 years and then decline.

Younger generations have different diets and suffer more from diseases like obesity and diabetes. And fewer and fewer people grow what they eat.

But Saturnino Lopez, a father of nine, remains active.

“My children say to me, ‘you no longer work. We have to work to support you.’ But I don’t like that, because I know what keeps me going,” he said, referring to physical activity like cutting wood.

“Even if it is just a couple of blows with the machete, that’s enough.”